NExT Region CPSO Media Release Form

Regional Tournament - Plano, TX - February 26, 2022

Each Team Member and TeamManager must fill out a copy of this form. Persons under 18 years of age must have their parent’s or guardian’s digital signature on the form. Completed forms must be submitted before checkin at the NExT Regional tournament.

Submitting this form permits the organizers and sponsors of Texas Destination Imagination program to use videotapes and photographs of participants in public showings.

Digital Signature for Team Member

I hereby consent to Texas Destination Imagination (TXCPSO, Inc.), its regions and its licensees to use my picture for purposes of trade or for any lawful purpose whatsoever.

Participant Name

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date

MM

DD

YYYY

School or Organization

Team Manager's Name

First Name

Last Name

Team Number

Grade

Persons under 18 years of age must have consent of parent or guardian

I, the undersigned, being the parent or guardian of the above minor, do hereby consent to, and agree to be bound by the above release.

Name

First Name

Last Name